Background Among women infected with the human immunodeficiencyvirus (HIV), there is a high prevalence of human papillomavirus(HPV) infections. However, little is known about the naturalhistory of HPV infections in HIV-seropositive women, and persistentHPV infections may explain the increased risk of cervical squamousintraepithelial lesions and invasive cervical cancer in HIV-seropositivewomen.
Methods A total of 220 HIV-seropositive and 231 HIV-seronegativewomen in the New York City area were evaluated at two or moresemiannual gynecologic examinations that included a Pap test,a test for HPV DNA, and colposcopy.
Results HPV DNA was detected at the initial examination in 56percent of the HIV-seropositive and 31 percent of the HIV-seronegativewomen. After four examinations, the cumulative prevalence ofHPV infection was 83 percent in the seropositive women and 62percent in the seronegative women (P<0.001). Persistent HPVinfections were found in 24 percent of the seropositive womenbut in only 4 percent of the seronegative women (P<0.001).Twenty percent of the seropositive women and 3 percent of theseronegative women had persistent infections with HPV-16–associatedviral types (16, 31, 33, 35, or 58) or HPV-18–associatedtypes (18 or 45) (P<0.001), which are most strongly associatedwith cervical cancer. The detection of HPV DNA in women withpreviously negative tests was not associated with sexual activityduring the interval since the preceding examination.
Conclusions HIV-seropositive women have a high rate of persistentHPV infections with the types of HPV that are strongly associatedwith the development of high-grade squamous intraepitheliallesions and invasive cervical cancer. These persistent infectionsmay explain the increased incidence of squamous intraepitheliallesions in HIV-seropositive women.
Source Information
From the Department of Pathology, College of Physicians and Surgeons (X.-W.S., T.C.W.), and the Gertrude H. Sergievsky Center and Division of Epidemiology (L.K.), Columbia University, New York; the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta (T.V.E., T.J.B.); and the Bureau of Disease Intervention Research, New York City Department of Health, New York (M.A.C.).
Address reprint requests to Dr. Wright at the Department of Pathology, Room 16-402, College of Physicians and Surgeons, Columbia University, 630 W. 168th St., New York, NY 10032.
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